Utilization Review Coordinator jobs in Nevada
Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Recently Added Utilization Review Coordinator jobs
Utilization Review Specialist (40952)
- WestCare
-
Henderson, NV
FULL_TIME
-
Position Summary
Person in this position is responsible for collecting clinical information and communicating with MCOs in a timely manner in order to advocate for the highest level of care that is supported by the clients acuity, and in compliance with regulations as defined by WestCare and its regulatory and accrediting agencies. Person in the position is also responsible for communicating with insurance companies/payor sources as an advocate for the patients served. Essential functions include those listed below
Essential Job Functions- Establish and maintain positive and frequent effective communication with insurance carriers
- Read and understand patient/members running chart narrative and respective case notes and be able to disseminate patient needs and professional/clinical recommendations and communicate this information effectively
- Call in intakes and/or peer to peers and get the patients appropriate level of care authorized
- Obtain and communicate level of care and authorizations and properly enter information into the systems.
- Manually complete and submit quality authorization documentation to insurance companies
- Serve as an advocate for patient members in relation to their care and their insurance benefits
- Responsible for tracking current & concurrent authorization needs in all levels of care
- Responsible for detailed system documentation of accounts
- Communicating with other departments to obtain or provide needed information on patient accounts.
- All other related duties as assigned
Essential Qualifications:- None required
- Associates or Bachelors level LPN or RN and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric or
Experience And Competencies- Proven experience in conceptualizing a case and creating a clinical impression to present to all involved and approved parties, including managed care representatives
- Knowledge of CPT, ICD 9 & ICD 10 coding, ASAM, medical terminology and EMR/CDS Systems.
- Proficiency in Microsoft Office Platform Applications and knowledge of HIPAA regulations and guidelines.
- Knowledge of managed care and reimbursement principles.
- Understanding and proficiency in State of NV Medicaid Chapter requirements
- Collaboration, negotiation, and assertiveness skills.
- Must be organized, detail oriented and have the ability to focus on several job-specific tasks with several potential surrounding distractions and patient traffic.
- Excellent verbal and written communication skills.
- Critical thinking and problem solving skills.
- Must be able to work in a team environment.
- Ability to perform complex tasks and to prioritize multiple projects.
- Strong analytical and critical thinking skills and the ability to analyze, summarize, and effectively present data.
- Ability to work collaboratively with others in a manner that is pleasant and professional.
- Ability to exercise good judgment and discretion.
- Ability to operate a computer and complete documents in Microsoft program formats.
- Ability to complete work tasks within scheduled work hours.
- Excellent verbal and written communication skills.
- Work is performed primarily in a professional, office setting.
- A minimum of 40 hours per week are expected but significantly more hours may be required from time to time. Regular attendance is required.
The employee must be able to perform the following essential duties and activities with or
Without Accommodation
Physical Demands:- Use of computer and telephone systems is required which includes coordination of eye and hand, and fine manipulation by the hands (typing, writing, and working with files).
- Requires talking: Expressing or exchanging ideas by means of the spoken word. Talking is required to impart oral information to employees, clients, and the public, and in those activities in which the employee is required to convey detailed or important spoken instructions to others accurately, loudly, or quickly.
- Requires hearing: Hearing is required to receive and communicate detailed information through oral communication.
- Requires seeing: Clarity of vision at 20 inches or less and at distance. This factor is required to complete paperwork for many of the employees essential job functions and to observe activities in and out of the facility.
- The normal work routine involves no exposure to human blood, body fluids or tissues. However, exposure or potential exposure may be required as a condition of employment. Appropriate personal protective equipment will be readily available to every employee
- Requires the ability to collect and analyze complex numerical and written data and verbal information to reach logical conclusions.
- Requires the ability to work and cooperate with clients, co-workers, managers, the public and employees at all levels in order to exchange ideas, information, instructions and opinions.
- Requires the ability to work under stress and in emotionally charged settings.
- 7 Days Ago
Utilization Review Specialist
- WESTCARE INC
-
Henderson, NV
OTHER
- Job Details Job Location: Henderson - 1711 Whitney Mesa - Henderson, NV Position Type: Full Time Education Level: 2 Year Degree Salary Range: $45,000.00 - $45,000.00 Salary Job Shift: Any DescriptionP...
- 9 Days Ago
Utilization review specialist
- Westcare Foundation, Inc.
-
Henderson, NV
FULL_TIME
- Job Details Job Location Henderson - 1711 Whitney Mesa - Henderson, NV Position Type Full Time Education Level 2 Year Degree Salary Range $45,000.00 - $45,000.00 Salary Job Shift Description Position ...
- Just Posted
Utilization Review Technician
- North Vista Hospital
-
North Las Vegas, NV
CONTRACTOR
- Overview At North Vista Hospital, our dedicated team of professionals are committed to our core values of quality, compassion, and community. As a member of Prime Healthcare, a Top-15 hospital system ...
- 1 Day Ago
Utilization Review Specialist
- Reno Behavioral Healthcare Hospital
-
Reno, NV
FULL_TIME
- The UR Specialist reviews and monitors patients' utilization of health care services with the goal of maintaining high quality, cost-effective care. The duties include providing the medical and utiliz...
- 18 Days Ago
RN Case Manager/Utilization Review, Part Time
- Northern Nevada Medical Center
-
Sparks, NV
PART_TIME
- Responsibilities: This RN Utilization Review/Case Manager opportunity is par time at 24 hours per week, offers full benefits and a convienient day shift schedule. When it comes to choosing a hospital,...
- 2 Months Ago
Utilization Review Coordinator jobs at Popular Companies
Continuing Care Utilization Review Coordinator Registered Nurse (Skilled Nursing Experience Highly Preferred)
- Kaiser Permanente
-
Redwood City, CA
- Description: Job Summary: Conducts utilization review for in-house patients and/or those members at contracted facilitie...
- 6/11/2024 12:00:00 AM
Utilization Review Coordinator RN
- MyMichigan Health
-
Midland, MI
- Summary: This position plays a pivotal role in maintaining the fiscal health of the organization by ensuring the organiz...
- 6/9/2024 12:00:00 AM
HHS Utilization Review Coordinator - Behavioral Health
- Napa County, CA
-
Napa, CA
- Salary : $126,568.00 - $151,486.40 Annually Location : Napa, CA Job Type: Full Time Job Number: 2062-2023-11-02 Departme...
- 6/9/2024 12:00:00 AM
Utility Supervisor
- StarPlus Energy
-
Kokomo, IN
- Company Overview: STARPLUS ENERGY LLC is an electrifying joint venture between Samsung and Stellantis. With a focus on i...
- 6/9/2024 12:00:00 AM
Utilization Review Coordinator / Case Management / PRN
- Christus Health
-
Santa fe, NM
- Description POSITION SUMMARY: Registered Nurse uses approved screening criteria (MCG®/CMS Inpatient List) to determine t...
- 6/8/2024 12:00:00 AM
Utilization Review Coordinator
- COLLABORATIVE NEUROSCIENCE NETWORK LLC
-
Long Beach, CA
- Job Description Job Description Facility Overview At Ocean View Psychiatric Health Facility, we are committed to serving...
- 6/8/2024 12:00:00 AM
Utilization Coordinator
- Tenderheart Health Outcomes
-
Albany, NY
- Job Description Job Description For nearly two decades, TenderHeart (formerly known as Longhorn Health Solutions) has be...
- 6/8/2024 12:00:00 AM
Utilization Review Coordinator
- TheraMatrix
-
Pontiac, MI
- Job Description Job Description Duties and Responsibilities: Initial authorizations of outpatient physical therapy servi...
- 6/7/2024 12:00:00 AM
About Nevada
Nevada is almost entirely within the Basin and Range Province, and is broken up by many north-south mountain ranges. Most of these ranges have endorheic valleys between them, which belies the image portrayed by the term Great Basin.
Much of the northern part of the state is within the Great Basin, a mild desert that experiences hot temperatures in the summer and cold temperatures in the winter. Occasionally, moisture from the Arizona Monsoon will cause summer thunderstorms; Pacific storms may blanket the area with snow. The state's highest recorded temperature was 125 °F (52 °C) in Laughlin (e...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Coordinator jobs
$81,321 to $100,734
Most Popular Cities in Nevada for Utilization Review Coordinator Jobs
What does an Utilization Review Coordinator do?
Utilization Review Coordinator in Long Beach, CA
The Utilization Review Coordinator contributes to moderately complex aspects of a project.
January 05, 2020
Utilization Review Coordinator in Gary, IN
Candidates for this role must have a good understanding of medical terminologies, and stay tuned with latest developments in the field; they should possess knowledge of reviews such as MAC, KEPRO, and RAC; strong observing skills and the ability to monitor safety plans are also needed.
December 29, 2019
Utilization Review Coordinator in Chicago, IL
Including requirements, responsibilities, statistics, industries, similar jobs and job openings for Utilization Review Coordinator.
December 30, 2019